Short-term Readmission Rates Similar After TAVR vs SAVR

Readmission within 30 days of
aortic valve replacement is relatively common but occurs at comparable rates
whether patients undergo TAVR or surgery, according to a study published in the
August 2015 issue of Circulation:
Cardiovascular Interventions.

Edward L. Hannan, PhD, of the
University at Albany (Rensselaer, NY), and colleagues examined data from New
York’s Cardiac Surgery Reporting System on 617 patients with severe aortic
stenosis who underwent TAVR and 1,981 who had surgical aortic valve replacement
(SAVR) between January 2011 and November 2012. Those data were linked with
information from the state’s administrative acute care database to determine
rates of and reasons for readmission.

After propensity matching, 389
pairs of patients undergoing either TAVR or SAVR remained; all matched pairs
came from the same hospital.

Rates of readmission within 30
days were similar both overall and among specific subgroups. The results were
consistent after adjustment with a logistic regression model (table 1).

Further analysis of the 30-day
period found that readmissions within 0-3 days and 21-30 days were similarly
likely in the TAVR and SAVR groups. There were, however, more readmissions in
surgical patients at 4-10 days and more readmissions in TAVR patients at 11-20
days.

The most frequent principal
diagnosis among readmitted patients was heart failure in both the TAVR and SAVR
groups (21.9% and 19.2%, respectively). Other common diagnoses after TAVR
included postoperative infection (11.0%), hemorrhage or hematoma (5.5%), stroke
or TIA (4.1%), and respiratory failure (4.1%). After surgery, they included
cardiac rhythm disorders (9.6%), stroke or TIA (5.5%), pneumonia (5.5%),
pneumothorax/pleural effusion (5.5%), and GI bleeding (5.5%).

Median total length of
stay—incorporating the index hospitalization and any readmissions—was 9 days in
the TAVR group and 11 in the SAVR group.

Readmission Rates Higher Than With CABG

Because TAVR is less invasive, it
could be hypothesized that the procedure would be associated with lower
readmission rates compared with surgical valve replacement, although that has
never been formally tested, the authors say.

The current study does not
support that hypothesis and shows that readmission rates after TAVR and SAVR—which
approach 20% for both—are higher than the rate seen following CABG in New York
(16.5%).

Dr. Hannan and colleagues note
several caveats, however, including the potential impact of selection biases in
observational studies; the issue was minimized, though not eliminated, through
propensity matching and logistic regression modeling.

Additionally, when constructing
the models, the researchers did not have information on certain key patient-level
data including frailty, severe hepatic disease without failure, severe
pulmonary hypertension, cognitive impairment, and socioeconomic status.

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